The Use of Verbal Autopsy in Attributing Cause of Death from Epilepsy

Verbal autopsy (VA) is a method used increasingly in low-income countries to ascertain the likely cause of death. Originally developed for use in pediatrics and infectious disease, it is also useful in situations with poor data on adult mortality. Using information on cause of death ascertained through interviews with relatives or other associates of the deceased, assessment of the likely cause of death is performed by expert clinicians. Methodological issues related to the VA method include robustness when dealing with less-frequent causes of death; use of open or closed mortality classification; and possible selection bias in assessing cause of death. However, alternatives, including death certification, share many sources of imprecision. The clear advantage of the VA method is that it does not depend on access to clinic services, although clinical experts are used for the classification process. Even this may be challenged by the development of algorithms for the automatic coding of cause of death. VA has not been systematically applied to studies of causes of death in developed countries where physicians are available to complete death certificates. However, in studies of sudden unexplained death in developed countries, techniques similar to VA are used to ascertain circumstances surrounding death to be able to potentially classify it as sudden and unexplained. Thus, family and friends of the deceased are potentially valuable contributors, using the VA methodology: VA is useful in low-income countries to estimate the burden of epilepsy on all-cause mortality and, in industrialized nations it offers insights into sudden death from epilepsy.